Electronic health record (EHR) adoption rates in hospitals increased by an average of 3.2 percent annually in the period before implementation of meaningful use (MU) incentives. But in the period after MU, the average annual increase was 14.2 percent, according to new research in Health Affairs.
As study authors—Julia Adler-Milstein, Ph.D., an associate professor in the School of Information and School of Public Health (health management and policy) at the University of Michigan, and Ashish K. Jha, M.D., is the K. T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health in Boston—noted, the extent to which recent large increases in hospitals’ adoption of EHR systems can be attributed to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is uncertain and debated.
Because only short-term acute care hospitals were eligible for the act’s meaningful use incentive program, the researchers used national hospital data to examine the differential effect of HITECH on EHR adoption among eligible and ineligible hospitals in the periods before (2008–10) and after (2011–15) implementation of the federal MU program. They found that annual increases in EHR adoption rates among eligible hospitals went from 3.2 percent in the pre-period to 14.2 percent in the post-period.
Ineligible hospitals experienced much smaller annual increases of 0.1 percent in the pre-period and 3.3 percent in the post-period, a significant difference-in-differences of 7.9 percentage points. “The results support the argument that recent gains in EHR adoption can be attributed specifically to HITECH, which suggests that the act could serve as a model for ways to drive the adoption of other valuable technologies,” the researchers stated.
The study’s authors used data for the period 2008–15 from the Annual Health Information Technology (IT) Supplemental Survey of the American Hospital Association. This period included three years before and five years after the initiation of the meaningful use program. After merging that data, the sample consisted of more than 25,000 total observations and more than 5,000 unique hospitals.
The primary measure considered was whether or not each hospital had adopted at least a basic EHR in each year. Using a definition from a previous study, they considered a hospital to have at least a basic EHR if it reported full implementation of the following ten computerized functions in at least one clinical unit of the hospital: recording patient demographic information, physician notes, nursing assessments, patient problem lists, patient medication lists, and discharge summaries; viewing laboratory reports, radiologic reports, and diagnostic test results; and ordering medications.
According to the authors, these findings have implications for future policy efforts that seek to spur technology adoption, and they suggest that financial incentives tied to technology adoption are likely to substantially speed uptake across a range of hospital types.
Also of note, they said that hospitals have organizational capabilities to understand and react to complex incentive programs such as meaningful use incentives that are lacking in ambulatory practices. And it’s also possible that the different results are explained by the increasing maturity of the EHR market. In 2009, when HITECH was passed, the ambulatory EHR market was less mature than the hospital EHR market, they said.
